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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS u'= W <br /> OWNER S TELEPHONEco <br /> _ _ <br /> MAILING ADDRESS �� �O L /� n � �� GD <br /> PROPERTY ADDRESS <br /> o i <br /> LEGAL DESCRIPTION c- C) <br /> o <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWELL DDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUC7UR vi <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO I7 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> p <br /> COMMERCIAL BUILDING ❑ C McMlERnCIAL�AjD IT`,ION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ � <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin; Com ercial B siness; Br om; Deck; etc.) <br /> BUILDING CONTRACTOR: 74ew <br /> n <br /> O $ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/t X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m '' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 5 <br /> AND INDICATE NORTH (N). I N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES �J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 1 �, O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE \ CJf• ,� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. IF <br /> \ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. t w P--, C> <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER N <br /> SETBACK AREA. <br /> ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. annnnao -0 <br /> R A tf O O O N 6� ts9 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all I❑ d d a ! .j <br /> information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this ` a 9 m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c u ;,,d,;'"N b <br /> application. I agree to permit county officials charged with adminlstrating county ordinances or other authorized person to have ^ d Z 0 0 o o r" <br /> access to the above-described premises at any reasonable time for the purpose of inspection. ;,U o c Y <br /> OWNER'S SIGNATURE /v�/ 6 may'0 0 0 0 0 <br /> �^ na11) <br /> (date) a g 3 d = 2 <br /> Fa H S <br /> ZONING ADMINISTRATOR <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ON YEARqROM DATE OF IS�sUANCE N o U o <br /> e✓m�� Iii (�rp( �p z j mil /Alla <br />